The synergistic approach in homoeopathic practice

by Rajan Sankaran, Sneha Thakkar, Rishi Vyas

A contemporary approach
in homoeopathy, termed Synergy, has evolved over the last thirty years. It has proved to be advantageous when utilized in homoeopathic practice, and is overall a
clinically successful method. While utilizing the
fundamental and traditional tools of homoeopathy, such as the Materia Medica,
the Repertory, and the Organon, the Synergy method also values the newer approaches, such as Sensation, Kingdom, Miasm, and Source understanding.

This is a system that
is unique – its design can be taught, practiced, and replicated successfully by
students and practitioners. This method has brought together both the
old and the new approaches in homoeopathy – it has established a universal
platform where all approaches in homoeopathy are welcomed and used to aid in
the patient’s recovery.

This triangle figure represents
the Synergy concept in homoeopathy.

The peak of the
triangle is the Genius. Genius here means the prevailing spirit or distinctive
character of something – this applies to the patient and also to the remedy, as coined by Dr. C.M. Boger. In the preface to Boger’s
Synoptic Key, he states: “The strain which runs through every pathogenetic
symptom complex has been called the genius
of the drug.” The first few lines about each remedy in Boger’s Synoptic
Key usually give a very good idea of the remedy’s genius. This general quality of the patient and
of the remedy has also been called, by various authors in homoeopathy, the
essence, keynote, soul, red line, or the grand generals.

GENIUS

The
sides of the triangle, Symptoms and System, complement each other, and when
they are used together the best results ensue. Symptoms include the use of
rubrics, structured repertorization, keynotes, provings, characteristics, and
clinical symptoms. The System includes kingdom, sensation and miasm.

When the System areas are used synergistically and in
complete unison with traditional methods of analysis, the view of the case and
of the remedy is widened. This allows for the greatest understanding of what is
to be cured in disease, and what is curative in a remedy.

The Anchor is a tool
utilized alongside the Synergy Triangle and emphasizes the application of
complete symptoms (location, sensation, modality, concomitant) along with the
very characteristic, sure symptoms to create a reliable repertorization graph,
which is free of interpretation or bias.

When utilizing the idea of “Synergy”, all three sides of the triangle
(Genius, Symptom and System) plus the use of the Anchor tool, must be included
in prescription, and ultimately each one will reach the same conclusion and
remedy that matches the patient.

Each
side of the Synergy Triangle and other additional tools will be examined further
with representative figures.

When looking at the
Genius of remedies, the Genius of the patient and of the remedy must always be
in the backdrop when trying to match the two together. Some examples:

–
Plumbum– slow, insidious processes, having violent side symptoms, often of a
very changeable or incoherent character, coming in single parts.

–
Stramonium – remedy of terrors but lacking in pain, with suppressed excretions,
passing neither urine or stool, dreads darkness, horror of glistening objects,
fearful, desires company or escape. Further, if we
look at the fright and terror of Stramonium, it is there in the
system understanding, in the symptoms, and in the genius. It is centre part of
all three.

SYSTEM

The
System side of the triangle includes many piece of the patient. The System of
the patient can lead to Kingdoms, Sensation, Miasm, or Source.

When
we examine the System area in a given case, it is a Right Brain Experience.
This is the artistic side, creative, holistic, concepts, and perception.

SYMPTOM

When talking about the Symptom side of the triangle, Rubrics
and Structured Repertorization, Materia Medica, Keynotes, Provings,
Characteristics, and Clinical Symptoms are critical to prescription. When investigating the Symptom area in a
patient, it is a Left Brain Experience, which is the side of science, analytic,
math, logic, and grammar.

The key to success is flexibility and keen
observation skills. In any given case there can be very clearly marked Symptoms
and rubrics. Sometimes in a given case there can be a very clear System or sensation
– homoeopaths must be able to delineate betweenthese, yet merge all together
to ensure they each come to the same conclusion. This is the art of
case-taking, and therefore will allow the homeopath to see that no matter which area the case starts in, the other areas must follow closely behind (Genius,
Symptoms or System).

THE ANCHOR

The Anchor is the first, clear, sure, definite, concrete
thing we see in the case. The primary characteristic of the anchor is that it
must be clear and sure. Even more central to this is the degree to which this
symptom is unconditional in the patient - the more individual it is, the more
dependable it gets. An
Anchor is a solid and dependable characteristic that goes beyond
interpretation. The anchor can come from any aspect of the case, as
illustrated below.

When trying to understand a patient there must be a solid grasp of the
area that is most obvious in that case. It may be the Genius, the Symptoms, the
System or the Anchor. By following this clear and definite lead, the other
areas will also become evident. It is important to note that in cases sometimes the
Symptoms are clear, or the Genius is clear, or the System is clear – however,
in order for a successful prescription, all must be reconstructed and utilized
in the same way.

Conclusion

I
believe that most cases, approximately 90% of them, can be done in 15-20
minutes. The remaining 10% will take little more time. This is because the
obvious thing, the most central thing in the case, should be found and investigated.
If you have to search and search in a case, then it is not a central focus!

You
have to use the old and new things together – use both System and Symptom. The
System will give you the crux and the Symptom(s) will give you the hard facts,
the inarguable data. Suppose you come through rubrics and repertorizing to the
remedy, you then have to see is that the sensation and the experience also
matches.

My
advice is to learn thoroughly and slowly, and this will be good for a new
homoeopath. In the following case, you have to think what is central – and now
we know that the one string that ran through and through in her case it is
fear.

The Synergy approach to homeopathic case-taking provides a much needed
integration and unification between the old schools of thought and the new. The
advantages of this approach are that it is highly reproducible and provides
homeopaths with a newfound confidence in their clinical practice.

Illustrative Case Example of the Synergistic Approach

Case of Meige’s Syndrome

This is a case
of an elderly male patient who came to me with a diagnosis of Meige’s Syndrome.
His daughter accompanied him to the appointment because at times, the syndrome
made his speech unclear. Medically, this disease causes a spasm in the face
(eye and mouth areas). Generally, the only solution or treatment in the
allopathic field is using botox.

For this patient
in particular, his left side of the eye goes into spasm, he is unable to speak
properly, his jaw and tongue goes into spasm, and he has to clench it again and
again.

The patient is
of a higher class and is known for being a successful and important figure and
public speaker in the entertainment industry.

On observation,
his feet were constantly moving and he appeared to be restless during the case
taking.

D: Tell me
please, what is the main problem?

P: I am not able
to speak because of this Leigh’s Syndrome. My major problem is eating and
speaking. My eyes forcibly close anytime, when talking or at anytime. I have a
severe speech problem and I have to exert a lot for speaking. My muscles get
stiff. Like I have to speak and I cannot speak, I feel stiffness. I cannot
sleep properly because of this either. Also, in the mouth, there is total
dryness.

D: One problem
is a spasmodic closure of eyes, and then stiffness around mouth that prevents
you from pronouncing words?

P: Eating also
is a problem. I have to chew, but I am not able to. There is no control of my facial
movement. It is not all the time now, but when it started it was continuous. It
comes between 12-3 pm and after 6pm-9-10 pm.

D: These two
times of the day the problem is more?

P: Particularly
more, but it comes anytime.

D: Anything more
about this problem? Can you give details?

P: My left side
of the eye goes into spasm. It shuts suddenly and I cannot see. I am also
unable to speak properly and this bothers me most. My jaw and tongue goes into
spasm, and I constantly have this clenching motion.

Commentary:from this point in the case, we know the
patient’s diagnosis and pathology. Also, we can look in our repertory for the
peculiar characteristics and symptoms that he displays. The rubrics we can
examine are in the eye chapter, where the eyes close involuntarily and there is
spasmodic and convulsive action. Also,
we should look in the mouth chapter for spasms of the mouth and tongue. We can
anchor ourselves on these symptoms because they are concrete, sure, 100%
reliable, and not interpreted.

D: Any other
symptoms or troubles you have?

P: Just cold and
cough. I cannot sit in air conditioning or I cannot sit under a fast fan. The
smallest draft of air aggravates me and all of my problems increase.

D: Tell about
your cough and cold?

P: In the cold,
I have lots of phlegm coming out through my nose.

P2 (Patient’s daughter):
Every month he gets a cold and thick discharge comes out from his nose. He even
gets fever from this. He cannot go to a cold environment because that makes
this condition worse.

When he is
eating, food comes out of his nose. He is famous for his speech but since the
disease has started he has gotten worse. Sometimes he has to hold his face and
speak. Only we can understand what he says.

Commentary:at this point in the case, we have a
strong modality of being aggravated by cold, aggravated by a draft of air and
fanning.

D: So his speech
becomes indistinct and unclear?

P2: Yes. He
cannot enjoy food either and gets embarrassed because he cannot eat properly.

D: You said he
is famous for his speech?

P2: He studied
in the entertainment industry and he was a good speaker. He even received an
award for it.

P: My job was in
consulting but now my speech has gone. So now I am in total frustration. This
disease harms my work, and in what I am earning. I only earn from my speaking.

D: What is your
nature of work?

P: I have to go
to actors and directors, convince them about a project, do all the castings,
attend and do speeches at many various award functions, and sometimes I even
design the whole show.

D: What are the
qualities needed?

P: Total
knowledge of the industry. Talent. Creativity. Marketing ability. You have to
understand the market position and you have to study the marketability. Market
research and the capacity to execute everything are important. Talent is
definitely needed for this. Also, one should have good relationships and
contacts, and be successful at thinking out of the box and planning. For me,
every day is a new day at work. I cannot apply a formula of one project to
another. I need to design and tailor the program for each project. You need to
be able to speak, but now I cannot and that is what I am lacking. My
presentation is lacking even though I am an expert. Now, I am losing. I am
confident but it still affects me. My daughter is the number one actress in
Gujrat. She is taking after me, her father, so she has become quite famous and
big. I liked it when people told me that I sounded good and my voice was clear.
I liked when they complimented me for my speech. I had to perform in front of
so many in the industry and everyone liked my speaking. I felt special when
this used to happen to me. Now, I am losing it all.

D: Do you have
any dreams?

P: No. I sleep
soundly.

D: Were you
nervous before this disease, when you spoke?

P: I was very
affected, but I was confident, damn confident! I am always ready for a speech.
If in any function I was asked to speak instantly and impromptu, I could speak
– and I could speak very well. I was unique and an inspiration to many in my
field. Now, I have this challenge.

Commentary: from here, we see a glimpse of the System
side of the triangle. This is a patient who believes he is someone special, not
average. He is longing for good opinion of others, and his whole life he has
been a speaker and has had to perform. The patient describes his field and explains
that he is creative and must be capable of doing research and planning to be
successful. He prides himself on his talent (of public speaking) and he is now
losing this talent.

All of these
themes can be classified into the Mineral Kingdom, where the patient has
achieved so much, but now is lacking or losing his own ability. More specifically, this patient can be put
into the fifth row of the Periodic Table, where the common themes include
creativity, talent, show, performance, challenge, uniqueness, admiration,
ambition, voice, and inspiration.

D: Are there any
other physical complaints?

P2: He has had 3
blocks in his heart and has been taking allopathic medicine for 20 years. I
have a feeling that the medicine has caused this problem.

D: Do you like
singing or not?

P: No. I do not.
I do not like dancing, I don't like parties. I am more a homey person.

D: How are you
about order?

P: I am very
well organized. I am very much disciplined. I like to do everything in a very
planned way. I am also very punctual. I am famous for my discipline.

P2: He was very
short tempered, but not now. Generally, he is a very soft spoken person but
very well spoken. He feels scared at night to drive or walk ever since his eyes
forcibly got closed.

D: This problem,
it comes and goes, does it?

P: Yes, it is
like an attack.

D: What do you
like most in food and drink?

P: I eat all
food, vegetarian and non-vegetarian. I like fish but I don’t have it now
because everyone is vegetarian in my family. So, when I go out for food, I have
fish.

D: Do you like
sweets?

P: Yes, I love
to have sweets. I used to have it every day, but now, my wife doesn’t give them
to me because of my health problems. I also love spicy food but I control this.

Commentary:the food craving is very important in case-taking. It can
confirm the remedy we are thinking. In this case in particular, the patient
craves sweets and wanted them every day.

D: Your feet
remain really restless?

P: Yes, they do.

D: Is there any
problem with your voice. Does your voice become hoarse?

P: Yes. My voice
often becomes harsh and hoarse because of this problem. I am losing my ability
to speak clearly.

D: How was his
original speech?

P2: His speech
was so clear and so nice. Now he is not speaking his original speech. His voice
was like pearls. Every word he spoke was beautiful. People would understand him
clearly and could tell it was his voice right away. He loved to perform. He was
so famous for his speech and I hear many people in the industry say that his
speech was so clear. People say that I have his voice too even, and they
appreciate it. He was working all over India, in radio, television and
film, and he even was interviewing actors.

Commentary:the theme of speaking, show and performance is very
prominent in this patient. His voice is also something that is instantly
recognizable and now he is unable to showcase his talents because of this
disease.

D: Did this
problem start slowly or suddenly?

P: This problem
suddenly came one day, and I realized it was a big problem. All of a sudden one
day, I couldn't open my eyes.

D: Okay, we will
give you a medicine.

Final
Commentary and Case Analysis

From this short
case example, we can utilize the synergistic approach. We see that the patient
believes he is someone special and not average; he is creative and enjoys
performing and showcasing his talent and ability. He is longing for a good
opinion from everyone in the industry but his main issue is this disease, which
is challenging his ability to perform, showcase himself, and be creative. This
shows the System Side of the triangle.

His main physical
symptoms include the peculiarities of the spasm pathology in the disease itself
and also the emphasis on his voice and public speaking. He is in the process of
losing his ability, but wants to maintain this position.

Rubrics Chosen:

1)
GENERALS,
COLD, agg.

2)
EYE,
EYELIDS, closure, involuntary

3)
EYE,
CLOSING THE EYES, spasmodic closure

4)
EYE,
COMPLAINTS OF EYES, left

5)
EYE,
OPENING THE LIDS, unable to

6)
NOSE,
DISCHARGE, thick

7)
NOSE,
DISCHARGE, mucus

8)
NOSE,
DISCHARGE, copious

9)
LARYNX
AND TRACHEA, VOICE, hoarseness

10) MOUTH, SPASMS

11) MOUTH, SPASMS, tongue

12) MOUTH, SPEECH, difficult

13) MIND, ANXIETY, anticipation
from

14) MIND, TIMIDITY, public about appearing in

Prescription:Argentum
metallicum 200C

I chose the remedy
Argentum Metallicum for this patient
because it was clear. The System side of the triangle was confirmed (kingdom
and row), and the characteristic Symptoms were also confirmed.

When it comes to
deciding the right column, we have to understand the level of stress. This
patient is stressed because he doesn’t feel he has lost the position he was
in, he simply feels that this spasm acts as a challenge to his position. He is
questioning himself – do I have the capability at the moment that this disease
occurs? He wants to maintain his position. He still believes he is on top but
is wondering if he will maintain his position there. Speech is a very critical
and important feature of the remedy Argentum, which falls in the 11th
column of the Periodic Table, where the main themes of this column include
maintaining, conserving, and sustaining his or her position.

The Genius of
the remedy is also represented. The main site of action for this remedy is on
the larynx. There is a loss of power in the patients needing this remedy.

Argentum (silver)
belongs to the second line of metals in the Periodic Table, where it lies
between copper and gold. Like other metal remedies, Argentum metallicum sees his survival in performance and
defence. The metals of the second line are concerned with show. Silver is a
showy metal, a shiny metal, a showpiece of human society. A good orator is
called silver-tongued. Funnily enough Argentum
metallicum has the symptom: "Tongue has a silver coating". It
is said "Silence is golden, speech is silver". Silver is not the
noble one but always the showy one. There is a strong intellectual component in
Argentum metallicum. Kent says it singles out mainly the
intellectual faculty, it scarcely affects the emotion. The Argentum metallicum situation is one
where the person has to perform intellectually and express himself through
speech, singing, writing, etc., and also has to defend himself by intellect,
speech and words.

In Argentum metallicum, one of the most important symptoms is
aggravation from using voice, aggravation from speaking, singing and mental
exertion. He can argue and fight very strongly and hard, not only for himself
but also for others. He has the ability to convince others and win over the
opposition with intellect; hence, the Argentum
metallicum person would make a very good lawyer or salesman.

Physical
symptoms of this remedy include spasms, convulsions and cramps.

Follow-ups

One month later

D: Tell me please, how
are you?

P: I am good.
Overall, I feel like I was 25% better after the first month. Mentally, I was
feeling good and confident because my spasms reduced. The frequency of the
spasms was much less, and if I did get a spasm it improved. But now, I feel the
disease is getting worse again.

Commentary: this is a good example of how potency
selection can make all the difference in homoeopathic prescription. We know
that the remedy acted in a positive way because of the 25% improvement in
symptoms, however, the improvement was not lasting. Thus, we can conclude that
this patient needs a continuous dosage and a lower potency. I gave him 30
potency, twice daily for a month.

Three months
later

D: Tell me, how
have you been since the last time?

P: To be honest
doctor, I am feeling much better. I can even hear my speech improving. People are
saying that it is clearer. I feel overall 50% better.

Commentary:after understanding the posology, we see that the patient is
doing much better and continues to improve. He was given Argentum metallicum 30 again.